With Congress heading out of town for a two weeks spring break – or, as they prefer to call it, a district work period – and HHS Secretary Sebelius riding off into the sunset, now is a good time to take stock of the health policy landscape and what lies ahead.
Congress’s kicking the can once again on the Sustainable Growth Rate (SGR) or “doc fix” into March 2015 along with other factors including the mid-term elections, continued rancor around the Affordable Care Act and transitions among leadership of key committee makes resolution of other major healthcare bills unlikely this year. With the nation’s debt ceiling also extended through March 2015, a “perfect storm” may be brewing in which the newly seated 114th Congress will address both issues – and maybe more – in one package during the first quarter of 2015.
Between now and then, stakeholders should continue remaining active, particularly to advance issues to maximize the likelihood they would be included within a March 2015 package. For example, last month the leaders of the Ways & Means and Finance Committees released draft legislation containing reforms to the Post-Acute Care (PAC) sector, which includes nursing homes, rehabilitation centers and home health. The bill recognizes the siloed nature of the current sector and seeks to move toward a common assessment and toward a payment system that focuses on the characteristics of the patient rather than the care setting. Leaders have expressed interest in continuing to refine this legislation over the coming months, and stakeholders in that sector should engage with the lawmakers if they have not done so already. Another bill that may gain traction is the Better Care, Lower Cost Act – a baby of new Finance Committee Chairman Ron Wyden of Oregon – that would provide additional tools to drive more coordinated care of chronically ill Medicare beneficiaries.
Outside of the delivery and payment space, Congress has been taking action on smaller health-related bills. A bill reauthorizing the program that provides for medical education or funding to train pediatricians at children’s hospitals and a bill that transfers funds used to subsidize political party conventions to a new fund to support pediatric research at the National Institutes of Health were signed into law earlier this month. Additional bills focused on research and public health issues may continue to move in the coming months.
Congress must also fund the government beyond September 30, 2014. The Appropriations committees in both chambers are moving forward to develop their respective spending bills, with House leaders aiming to complete committee work on all 12 bills before July 4th. But given the fiscal challenges and election year politics, it’s probably a safe bet that Congress will enact a temporary spending bill that runs until after the mid-term elections, with the outcome of the elections – particularly the balance of power in the Senate – determining the path forward in late 2014. If Republicans win enough seats to take back the majority, they will likely want to do another temporary patch so they can complete work on the package in the new year when they control the majority.
And now that Sec. Sebelius is stepping down and current OMB Director Sylvia Burwell being named to take her spot, the Senate will need to hold a confirmation hearing and vote on the Secretary-designee. While Burwell was approved for her current gig by a 96-0 vote and has received high marks from those on both sides of the aisle, acrimony over the ACA and other issues will likely make for a lively hearing.